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(DISTRICT USE ONLY) MONTH AND YEAR RECORDED: _____________
CHURCH REMITTANCE FORM
Church Name: ________________________________________________________________
Church Address: ______________________________________________________________
Date: _______________ Assembly Year To Be Credited (eg, 2015-16): ________________
DISTRICT EVANGELISM FUND (District Apportionments)
District Evangelism Fund (Goal: 5.0% of Adjusted Total Income)
District Matching Funds Payment (Payable by Assembly Time)
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_____________
EDUCATIONAL FUND (Olivet Nazarene University)
Educational Fund for ONU (Goal: 2.5% of Net Base)
District IMPACT Youth Choir Scholarship Fund at ONU
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_____________
DISTRICT MISSION PROJECTS (10% Mission Specials)
Church Plant (Specify: _________________)
Center of Hope (CMC)
INTRSCT (Urban Volunteers)
District-Based Work & Witness Projects
Other 10% Mission Specials Projects on District (____________)
_____________
_____________
_____________
_____________
_____________
OTHER DISTRICT PROJECTS (Not 10% Mission Specials)
Christmas Gift for Needy Pastors’ Families (List families _____________)
Summer Camping Ministries Scholarships
__________________________________________________
CHECK # ____________
TOTAL
_____________
_____________
_____________
_________
INSTRUCTIONS FOR COMPLETING THIS REMITTANCE FORM:
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Print your church’s full name (not simply “First Church”) and address on the lines provided at the top.
Enter the Assembly Year for which you would like to receive credit (e.g. 2015-16).
Remember the Assembly Year runs from March 1 through February 28/29. If sending monies for two
different Assembly years, please use two separate forms and send two separate checks.
Indicate your gift designation by placing an amount next to the appropriate designation.
If a designation is not listed use one of the blank lines provided to indicate your designation and amount.
Indicate the total amount of your gift on the line provided.
Indicate your Check # on the line provided.
Make your check payable to: Chicago Central District
Return this remittance form along with your check to the District Treasurer, PO Box 218, Bourbonnais,
Illinois, 60914
For World Evangelism Fund, Pensions Fund and Mission Specials, use the General Church Remittance Form.
NTS and NBC Offerings are sent directly to those institutions.
For District NMI Offerings, contact the District NMI Treasurer.
For questions, please contact the District Financial Secretary at mthomas@ccdnaz.org
Please DO NOT send cash.
Make additional copies of this form as necessary.
Local Church Remittance Form.docx -- 04/17/2015